Validation of Partin tables for predicting pathological stage of clinically localized prostate cancer

Purpose: The accurate prediction of pathological stage of prostate cancer u sing preoperative factors is a critical aspect of treatment. In 1997 Partin et al published tables predicting pathological stage using clinical stage, Gleason score and prostate specific antigen (PSA). We tested the validity of the Partin tables. Materials and Methods: From 1990 to 1996 inclusively 5,780 patients underwe nt bilateral pelvic lymphadenectomy and radical prostatectomy for prostate cancer at the Mayo Clinic. However, only 2,475 of these patients met all in clusion criteria of no preoperative treatment, known biopsy Gleason score, available preoperative PSA done either before biopsy or more than 28 days a fter biopsy and clinical stage T1, T2 or T3a. Among the 2,475 patients 15 h ad positive lymph nodes and planned prostatectomy was abandoned. The receiv er operating characteristics (ROC) curve area, observed and predicted Parti n rates of each pathological stage, and positive and negative predictive va lues were used to compare the Mayo study to the Partin tables. Results: The distribution of pathological stage was organ confined in 67% o f Mayo cases versus 48% in the Partin study, extracapsular without seminal vesicle or node involvement in 18% versus 40%, seminal vesicle involvement without nodes in 9% versus 7% and were positive nodes in 6% versus 5%. Usin g the predicted probabilities of Partin et al the ROC curve area for predic ted node positive disease was 0.84 for Mayo cases compared to an estimated 0.82 in the Partin series. The ROC curve area for predicting organ confined cancer was 0.76 for the Mayo Clinic compared to an estimated 0.73 for the Partin series. The observed rates of node positive disease were similar to those predicted (Partin) based on clinical stage, PSA and Gleason score. Fo r organ confined disease Mayo rates were consistently higher than those pre dicted from the Partin series using a cut point of 0.50 or greater. Positiv e and negative predictive values were 0.83 and 0.49 versus 0.63 and 0.70 fo r the Mayo Clinic and Partin series. Conclusions: Our study provides strong evidence that sensitivity and specif icity of the Partin tables for external clinical sites are similar to what was reported.